Coverage provided and underwritten by Ameritas Life Insurance Corp.
Eligible Duke employees scheduled to work at least 20 hours per week can choose from three dental options, depending on the extent of coverage you and your family may need.
All options cover Type 1 (preventive), Type 2 (basic), Type 3 (major) and Type 4 (orthodontia), but differ in how they pay for covered services.
Preferred Provider Option (PPO) Plan
The PPO plan includes a higher maximum annual benefit than Plan A and Plan B, lower negotiated procedure rates, and your out-of- pocket costs are usually lower. However, members in the PPO plan will need to select an in-network provider. If you select the PPO plan and use an out-of-network provider, the amount the plan pays will be based on discounted network charges and you will be responsible for any amount charged over that allowance. A list of network dentists is available at the Ameritas website or by calling Ameritas at 1-800-487-5553. When searching for an Ameritas network provider, select the Classic Network.
Plan A and Plan B
If you enroll in Plan A, you can select any licensed dentist of your choice, including a network provider. Using a network provider will limit your out-of-pocket cost. Also, if you utilize a network provider, the deductible is waived. Plan B provides a very basic benefit and payments are based on a fixed schedule of fees. The allowed benefit for all covered services under Plan B can be found in the certificate document and is available at the Ameritas website. You should review the fixed schedule before selecting Plan B.
- Dental Plans Comparison Chart
- 2023 Dental Premiums
- How to Increase Your Annual Maximum Benefit
- Questions to Ask: Making Your Dental Plan Decisions
- Late Entrant Restrictions on Benefits for 2023
How to Increase Your Annual Maximum Benefit
All three plans have an annual maximum benefit. If you reach this annual maximum benefit, Ameritas will not reimburse any additional services for the remainder of the calendar year. However, your Ameritas benefits include Dental Rewards.
Dental plan members who have at least one covered dental claim filed in the previous calendar year and have less than $500 in claims payments, will be able to carry over $250 of their unused annual maximum for future use. This Dental Rewards accumulation can continue to grow each year (until a maximum accumulation of $1,000 is met) if the member continues to have at least one covered service per year and paid claims in that year do not exceed $500. The Dental Rewards carryover is in addition to the annual maximum available under each dental plan option. If a member has a year when they have allowed dental services to go above their annual maximum, Ameritas will automatically pull from any Dental Rewards carryover that the member has accumulated.
NOTE: The Dental Rewards dollars cannot be applied to Orthodontia benefits.
Questions to Ask: Making Your Dental Plan Decisions
When comparing Duke's dental plans, it is important to compare out-of-pocket expenses as well as premiums. Here are some questions to ask yourself when choosing a dental plan that matches the needs of you and your family. For specific coverage information, please refer to the Dental Plans Comparison Chart.
| PPO Plans | Plan A | Plan B | |
|---|---|---|---|
| Can I visit any dentist? | No, you must use a network dentist | Yes, you may choose any licensed dentist or use a network dentist | Yes, you may choose any licensed dentist or use a network dentist |
| If I don't enroll within 30 days after my date of hire or eligibility and enroll in the future, will I be a "late entrant"? | Yes, please see below for more details | Yes, please see below for more details | Yes, please see below for more details |
| Will my dependent children who live in a different location be covered? | Yes, they may choose a dentist within a nationwide network | Yes | Yes |
| Is there a dental deductible before the insurance will pay for covered services? | Yes, an annual $50 deductible for "major" services | Yes, a $100 lifetime deductible for "basic" services and an annual $75 deductible for "major" services; the deductibles are waived if you use a network provider | Yes, a combined annual $50 deductible for "basic" and "major" services; the deductibles are waived if you use a network provider |
| Will I have out-of-pocket costs for preventive services? | No | Yes, cost sharing may be required if you visit a non- network dentist that charges above U&C | Yes |
| I need an existing filling replaced. Will it be covered if I enroll in a Duke dental plan? | Yes, if the filling is at least 6 months old | Yes, if the filling is at least 6 months old | Yes, if the filling is at least 6 months old |
| Are teeth whitening services covered under dental coverage? | No | No | No |
| Is a Pre-Treatment required? | We strongly suggest you ask your provider to submit a pre-treatment prior to expensive procedures such as crowns, bridges, root canals, etc. | We strongly suggest you ask your provider to submit a pre-treatment prior to expensive procedures such as crowns, bridges, root canals, etc. | We strongly suggest you ask your provider to submit a pre-treatment prior to expensive procedures such as crowns, bridges, root canals, etc. |
Late Entrant Restrictions on Benefits for 2023
If you and/or your dependent(s) are not currently enrolled for dental coverage through Duke and enroll for 2023, you and/or your dependent(s) will be considered a “late entrant”. As a late entrant your benefits during 2023 will be limited to preventive services: two preventive routine care exams (not including X-rays), two prophylaxis (routine) cleanings, and for children under age 19, one fluoride application. No other dental or orthodontia procedures or services will be covered during the first 12 months if a member is enrolled as a late entrant.
Once you have been enrolled in a Duke dental plan for at least 12 months, the plan will also cover basic and major procedures such as fillings, extractions, crowns, root canals and periodontal treatment (including periodontal maintenance, which applies towards cleaning frequency).
Periodontal procedures, including maintenance/ cleanings, would not be covered during this 12-month period. This 12-month waiting period does not apply:
- if you are switching from one Duke dental plan to another Duke dental plan,
- if you enroll an eligible dependent within 30 days of a qualifying event such as marriage or adoption, or
- if you add a child during an open enrollment period prior to his/her second birthday.